Joining the dots: nutrition programme delivery & health systems strengthening

It’s an exciting time to be involved in nutrition. Over the past decade, increased political attention – and of course funding – has enabled the field to take great strides. Yet there is still some way to go to reach the 2025 targets set by the World Health Assembly, and to ensure the post-2015 sustainable development goals for nutrition are, highly ambitions yet achievable.

The shift in the nutrition discourse from ‘what to do’ to ‘how to do’ has left us with the million-dollar question: how do we scale up nutrition interventions to reach all those who could benefit from them?To address this need, the International Society for Implementation Science in Nutrition (ISISN) has been launched, with the aim to “advance the development and use of systematic methods for effective implementation of nutrition interventions in low-resource settings.”

From prenatal nutrient supplements to treatment for moderate and acute malnutrition, and even efforts to control and reverse the obesity epidemic, one main delivery platform shines through: health systems. The organisations, institutions and individuals that make up the health system are often best placed to deliver nutrition interventions. In theory, the women and children targeted by these interventions should be in contact with their health system, through antenatal and postnatal visits, vaccination campaigns and opportunistic visits. Yet in reality, health systems are often over-burdened and under-resourced, meaning many people – especially disenfranchised and vulnerable groups – find it challenging to access and utilise the care and services they need.

Vitamin A supplementation
Vitamin A supplementation

The Scaling Up Nutrition (SUN) movement, with 54 countries now enrolled, is bridging some gaps in strengthening nutrition programme delivery platforms, yet there is a need to better align the nutrition agenda with that of health systems’ strengthening and research. The Global Nutrition Report 2014, released last week, identifies the need to advance the evidence base on how health systems can become more nutrition sensitive.

The authors state that more attention will be paid to “social protection, education, health systems, and women’s empowerment programs in future global nutrition reports”

Also last week the WHO and Micronutrient Initiative were holding a symposium on the determinants of access to health and nutrition interventions. One of the major challenges for both health systems and nutrition interventions is making sure that access and utilisation are equitable. It will be interesting to see how the outcomes of this meeting can advance the debate and action on how best to achieve this.

There are some significant challenges for both nutrition implementation science and health systems research to overcome. However, with the increased attention that both health systems and nutrition are getting, along with the ever growing influence and convening power of health systems global and the birth of ISISN, there can be optimism about the pace at which both these fields can advance.

Given the health and economic benefits of scaling up nutrition interventions, coupled with the need for a strongly functioning health system through which to do this, efforts to align these two agendas, where feasible, will ultimately result in a win-win situation for all.

Thanks for reading

Henry @henrymark88

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